Organization
CLERICO OPTOMETRY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN CLERICO O.D. (PRESIDENT)
(336) 924-6811
Entity
Organization
Contact information
Practice address
3528 YADKINVILLE RD, WINSTON SALEM, NC 27106-2535
(336) 924-6811
(336) 922-4375
Mailing address
3528 YADKINVILLE RD, WINSTON SALEM, NC 27106-2535
(336) 924-6811
(336) 922-4375
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0912
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09158
BLUE CROSS BLUE SHIELD NC
NC
05
—
8909158
—
NC
Enumeration date
02/28/2007
Last updated
04/20/2008
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